Provider Demographics
NPI:1407600166
Name:HOGAN, ALEXIS SAVANNA (OT)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:SAVANNA
Last Name:HOGAN
Suffix:
Gender:F
Credentials:OT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1513 SUNSET ST
Mailing Address - Street 2:
Mailing Address - City:MERKEL
Mailing Address - State:TX
Mailing Address - Zip Code:79536-6011
Mailing Address - Country:US
Mailing Address - Phone:325-721-4855
Mailing Address - Fax:
Practice Address - Street 1:1104 HENDERSON ST
Practice Address - Street 2:
Practice Address - City:SWEETWATER
Practice Address - State:TX
Practice Address - Zip Code:79556-6450
Practice Address - Country:US
Practice Address - Phone:325-236-6821
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-17
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT123179225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist